Severe Rhabdomyolysis Due to Presumed Drug Interactions of Dapagliflozin with Rosuvastatin: A Case Report

Abstract

Sodium-glucose-cotransporter-2 inhibitors (SGLT2i) and statins are increasingly used for reduction of cardiovascular mortality in type 2 diabetics. Few case studies reported an enhanced risk of rhabdomyolysis with this combination. A 57-year-old man with normal renal functions, developed fatigue and oliguria within three days of dapagliflozin addition to his preexistent rosuvastatin therapy. Investigations revealed severe acute kidney injury (AKI) with elevated serum creatine-phosphokinase (CPK) and myoglobinuria. Renal biopsy depicted severe acute tubular necrosis with interstitial nephritis and ropy myoglobin casts, which confirmed the diagnosis of rhabdomyolysis. Rosuvastatin and dapagliflozin were discontinued. Hemodialysis and oral steroids were prescribed. The AKI recovered within few weeks. Rosuvastatin was rechallenged after two months and his renal functions and CPK levels remained normal. This case demonstrates the incidence of severe rhabdomyolysis when an SGLT2i was added to an existing statin, emphasizing the importance of identifying drug-drug interactions and potential for myotoxicity.